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JOURNAL

Menopause: Natural, Surgical and Chemical

February 27, 2020

Menopause is an emotional time. It can represent the end of what we think of as our female youth, the start of the next phase of life, and for many, a long period of many uncomfortable physical changes. It’s a season in which our hormone levels decrease, and our body is forced to adapt, bringing forth symptoms such as hot flashes, disrupted sleep and mood swings, just to name a few.

For a lot of breast, endometrial and ovarian cancer thrivers, menopause can come prematurely – administered in the form of injections and/or pills to reduce estrogen levels, in attempts to prevent a recurrence. In this case, we’re hot-flashing at 35 instead of 55 or suffering from joint pain like we're well into our later years. We’re aged within days, and our body is left to adjust (or not) as best as it can. But there are some key methods that can help us alleviate discomfort. To discover ways of reducing symptoms and keeping our body vibrant in the face of menopause, read on. 

There are three ways that menopause can kick in – natural, surgical or chemical.

Natural

Natural menopause is a biological process that's marked by the end of a woman’s menstrual cycles. It's officially diagnosed when a woman has gone 12 months without a period and most commonly occurs in our 40s or 50s (the average age of menopause in the US is 51). In the years leading up to menopause (perimenopause), many of us experience symptoms such as irregular periods, vaginal dryness, hot flashes, chills, night sweats, sleep disturbance or insomnia, mood changes, weight gain, thinning hair, dry skin and loss of breast volume. The range or extent of these symptoms varies for each woman, and most do not endure all of them.

Surgical

Both hysterectomies (removal of the uterus) and oophorectomies (removal of ovaries) causes a cessation in periods, but only a bilateral salpingectomy (removal of fallopian tubes) and oophorectomy will bring on full menopause. While removing a uterus may cause a decrease in estrogen and initiate or worsen perimenopausal symptoms, when both ovaries and fallopian tubes are removed, we’re thrust into an immediate (and often severe) menopausal state. In fact, many patients claim that they woke up post-surgery in the middle of a hot flash due to the abruptness of the estrogen plummet. A hysterectomy is one of the most common procedures practiced in the US and is used to address endometriosis, endometrial cancer, fibroids as well as a form of birth control. Oophorectomies are less common and typically performed due to ovarian abscess or torsion, ovarian cancer, non-cancerous ovarian tumors or cysts, hormone receptor-positive breast cancer, or as a way of reducing cancer risk in women with inherited genetic mutations such as BRCA1 or BRCA2.1

 Chemical

Menopause can also be induced in pre- or perimenopausal women either as a result of chemotherapy treatments or with injections of gonadotropin-releasing hormone agonists (GnRH). GnRH agonists are responsible for the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the anterior pituitary gland. They can be used to lower testosterone levels in prostate cancer patients and suppress ovulation and estrogen levels in the breast or endometrial cancer patients. Such drugs as Lupron, Zoladex and Synarel are injected into the abdomen or buttocks monthly or quarterly and are often used in conjunction with aromatase inhibitors, or estrogen synthesis inhibitors, which further decrease estrogen levels.2

With all of these menopausal onsets, symptoms are consistent, even though they may vary in intensity. The following are a few handy tips we’ve discovered for getting through some of the discomforts. 

1. Fresh Air: For those prone to hot flashes, carrying portable fans are a great way to help the body cool faster. For little cost, one can find clip-on fans for bedside or foldable fans for a purse – making it easy to keep fresh air at the ready and cool the body faster in the face of a flush.

2. Layering Up: Because chills often follow a hot flash, it makes sense to wear easy-to-remove/put on layers such as cardigans or hoodies. It’s also best to wear natural, cooling and breathable fabrics – not synthetic ones that tend to stifle circulation of airflow. Scarves by day or wraps at night are good layering tools as well as cool, crisp sheets and blankets that can be easily taken off.

3. Flax Seeds: While studies are still being conducted and evidence is varied, there is some indication that eating two tablespoons of flax seeds per day, also known as linseed, can reduce hot flashes in menopausal women. Because flaxseed lignans have a weak estrogen effect, they may be able to replace natural estrogen in a breast cell’s estrogen receptor. While this effect is stated not to be strong enough to increase cancer risk, those with estrogen receptor-positive cancers should consult a doctor before introducing flaxseeds into a diet.3

4. Calcium-Rich Foods and Vitamin D: Hormonal changes during menopause can cause bones to weaken, increasing our risk of osteoporosis. Healthy levels of Calcium and Vitamin D have been linked to good bone health and a reduced risk of hip fractures. Dairy products, green leafy greens, beans, sardines and beverages fortified with calcium are great ways to allow food to be our medicine and supplement our health naturally.

5. Avoiding Trigger Foods: As much as we often love them, surgery and spicy foods may trigger hot flashes, night sweats and mood swings. Caffeine and alcohol too. It’s best to avoid them overall if possible, but especially towards the end of the day so as to prevent sleep disturbances. Maintaining a food journal can help us determine which triggers are our greatest culprits.4

6. Exercise: While exercise hasn’t officially been proven to reduce menopausal symptoms, there are many reasons why a strong regimen is critical. Regular, daily exercise strengthens bones, helps maintain body weight, relieves stress and improves the quality of life. Many say it also dramatically reduces hot flashes. Keeping our bones strong and our muscles supple is a key part to aging well, so we try to achieve a balance of aerobic activity, strength training, stretching and balance exercises throughout the week. It's important to note that if joint pain acts up or gets aggravated to consult a doctor. 5

7. Hydrate: Dryness is very common during menopause, due to decreased estrogen levels, so making sure to drink 8-12 glasses of fresh, filtered water is important. Water can also help reduce the bloating that commonly accompanies hormonal changes, as well as increase metabolism and prevent weight gain. It’s said that drinking 17 oz of water, 30 minutes before a meal, may encourage us to consume 13% fewer calories each day.4

8. Sleep: Everything is better with sufficient rest, but due to lowered estrogen and progesterone levels during menopause, it may feel impossible to achieve. Consider creating space for afternoon power naps or allowing more time to wind down at night and wake up in the morning. Even if our zzz’s come in fits and starts, more is more when it comes to supporting the body. There are also safe and effective sleep aids we can take. So, if bedtime is becoming synonymous with dread, be sure to inquire with a physician.

Depending upon how one enters menopause and the severity of our symptoms, this phase can feel like no big deal or a nightmare, especially when it occurs prematurely as a result of illness or other physical conditions. But knowing our body, keeping track of our sensitivities and attempting methods of regulating our symptoms can provide relief. Being gentle with ourselves and reducing stress is key, and hopefully, by doing so, our body will adjust swifter and with more ease into this next phase of life. 

“Listen, the best advice on aging is this: What’s the alternative? The alternative, of course, is death. And that’s a lot of shit to deal with. So I’m happy to deal with menopause. I’ll take it.” Whoopi Goldberg

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